This is your brain on opiates: the science behind addiction

By: Jack Kopanski and Taras Ustrytskyy

“Since 2007, in Ohio, your child has been more likely to die of an overdose than in a car accident.”

These are the words of Dr. John Sorboro, medical director at the Restorative Health and Recovery Clinic in Kent, Ohio.

Sorboro works directly with those affected by addictions of all kinds, specializes in medicinal treatments of addiction and has a strong understanding of the effects opiates have on a user’s brain.

“It’s the pharmacological response to turning on an opiate receptor,” Sorboro said, on why painkillers can lead to addiction. “Outside of the small portion of the population that has an adverse response when they take opiates, most people will report that after they use an opiate, they get a tremendous sense of emotional well-being. Many will say they’re still in pain, they just don’t give a shit.”

It’s these opiate receptors, located in a pleasure center of the brain, that will release increased levels of the chemical dopamine when turned on, Sorboro said. The euphoric feeling associated with the increase in dopamine is what drives people to want to continue using the drug.

Sorboro said one of the key issues facing a repeat user is the brain’s desire to continue self-administering, until it is all the user thinks about. This leads to a much more restrictive and limited life, and in turn, a stronger addiction.

When asked how much a pre-disposition to addictive behaviors influences  someone’s tendency toward addiction, Sorboro puts much more weight on the effect of one’s environment.

“It falls back on the standard model of us looking at our genetic code as something that is fixed,” Sorboro said. “That’s not the way our genes work; our genes are constantly evolving. Ninety percent of our genetic code is an on/off switch. Certain things are turned on depending on environmental exposure.”

Sorboro said he also sees a correlation between traumatic childhood experiences, such as parental substance abuse, and the child then developing a substance use disorder as well.

“There is a very high correlation,” Sorboro said, “But it’s not cause/effect.”

It is this correlation between traumatic events and opiate addiction that Doug Delahanty, professor of psychological sciences at Kent State University, focuses his studies on.

Delahanty hypothesizes there is an inherent connection between post-traumatic stress disorder (PTSD), and comorbid substance use disorder, citing some of the leading PTSD symptoms as reasons why those suffering turn to opiates. Comorbidity is the simultaneous presence of two chronic symptoms or conditions in a patient.

“You have intrusive thoughts,” Delahanty said. “It doesn’t have to be that intricate of a thing, but it’s memories that are distressing memories of the event. There’s avoidance symptoms – not wanting to do anything to expose yourself to triggers or reminders. One way to do that is to use substances. It facilitates avoidance.”

Delahanty’s research is also examining whether successfully treating PTSD will, in turn, lead to an increased likelihood of successfully treating substance use.

“We believe that you can complete whatever program there is for treating addiction, but if you still have the underlying psychopathology (of PTSD) there, and that’s what is driving the use, that person has the deck stacked against them for maintaining sobriety later on,” Delahanty said.

It is not just those who continue to experience PTSD symptoms who struggle to remain clean after recovery. Sorboro said this is an issue that faces almost all recovering addicts.

When an addict begins experiencing withdrawal after developing a new baseline for opiate use, the symptoms are those of increased hyperactivity, Sorboro said. Symptoms like excessive sweating, watery eyes and runny noses are common for those in recovery.

“The chronic slowing of normal intestinal contraction that occurs and is slowed by opiates, goes away and people get explosive diarrhea,” Sorboro said. “When you talk to somebody that has had opiate withdrawal, the single greatest fear that they have throughout treatment and in coming off of their medication, is that they’ll re-experience that. I think that that’s what you can attribute a lot of the cycle of use and relapse to, is the attempt to avoid those symptoms.”

Sorboro said these hyperactive symptoms do pass, but hypoactivity in the brain will follow, leading to bouts of depression, excessive sleep and chronic aches and pains. These symptoms pose another pitfall for those in recovery.

Another problem facing recovering addicts is when they return to their previous community, and have to re-immerse in a setting that was so familiar to them as an addict.

“Context cues are very important in this,” said Angela Junglen, a psychological sciences doctoral student at Kent State. “Whether it’s a pill bottle, just a phone going off, just that sound of a message was enough to be three steps ahead thinking that they’re going to be using soon. I think [it’s] definitely a struggle for them.”

When addicts continue to go back to using opiates, the chance of overdosing naturally increases. When this happens, Sorboro explains it all has to deal with the body’s respiratory system.

“It’s simply because opiate receptors bind to the respiratory centers of the brain stem, and these control out unconscious respiratory rate,” Sorboro said. “Once turned on, they slow down activity in this area of the brain, and people quite simply die from respiratory arrest. They just quit breathing.”

The number of recent overdoses has not gone unnoticed by Sorboro.

“The statistics in regard to overdose are really quite startling,” Sorboro said. “I hate to even imagine what the total will be in 2017.”

With the increase in these numbers, the continuing heroin and opiate epidemic is something Junglen said everybody has to think about.

“I think it’s important to realize that this can happen to anybody, and it’s not something that’s isolated to a certain section of people or that you would be able to identify what a heroin addict would look like,” Junglen said. “It really could be anybody.”

What is it that drives the mind of an opioid addict? Learn more about the brain chemistry of addiction here: https://t.co/lB4KZzPJ2c

— Jack Kopanski (@Jack_Kopanski) April 20, 2017